Prime Super's Murray Amies, First State Super's Jane Hogan (c), SuperFriend's Margo Lydon

SPONSORED CONTENT | One in five Australians in any given year will experience a mental health issue, and of those that stem from the workplace it costs the economy more than $12 billion a year.

What is less well known is that secondary mental health issues, where a psychological condition develops from a physical injury or illness such as cancer, is a significant contributor to the problem. A recent report by consultancy firm Deloitte showed that insurance claims for secondary conditions such as depression or anxiety were rising at a faster rate than primary claims. It also showed that the claims were four times more expensive and could triple the time that an employee takes off work.

While nationwide statistics on secondary mental health issues are hard to come by, anecdotal evidence from Australia’s superannuation industry suggests that it can account for as much as 60 per cent of claims from their members. Insurers and super funds say that early intervention and education is key to tackling the systemic problem.

“We’re quick to talk about primary mental conditions as being one of our top three causes of claims, but when you think about how many people actually have a secondary mental health condition it’s massive,” said Simonie Fox, group strategy manager rehabilitation and claims at AIA Australia. “Insurers, funds and employers have a responsibility to try to prevent people from becoming more unwell. There’s so much opportunity there.”

AIA’s Simonie Fox

Speaking at an AIA-sponsored roundtable on secondary mental health, Fox said the insurer was focussed on strategies that helped people who had taken extended time off work from injury or illness to get back to work before they developed a secondary mental illness such as depression. About 40 per cent of people diagnosed with cancer in Australia who then go into remission, for example, never returned to work because of related mental health issues, she said.

As a way of tackling the problem, AIA has developed health coaching and wellbeing programs as well as education around occupational rehabilitation. They are also adopting artificial intelligence and automation functionality to help manage claims and speed up the process for the customer before their health deteriorates further.

“That’s been a big shift for us and that basically covers 83 per cent of our claims,” said Fox in relation to the health coaching programs. “Mental health, cancer and musculoskeletal conditions make up our top three claims.”

Fox conceded that the life insurance industry was historically very process driven which had, in some cases, made people more unwell because they were forced to repeatedly discuss their disability. She said that AIA were now much more customer centric.

“We are flipping that around,” said Fox. “As an industry we need to do better to be educating Australians about how we can actually support people towards recovery. Post the Royal Commission that’s quite a challenging message to portray, because people then think we just actually want to get somebody off claim, when we actually want to help people recover as well.”

60-Day Waiting Period

TelstraSuper’s general manager of operations Kathryn Forrest told the roundtable that her top concern was addressing the extended waiting periods for insurance claims. She said shorter waiting periods were “critically important” for Australia’s largest corporate super fund, which would then help address further deterioration in a member’s mental health. About 60 per cent of TelstraSuper’s workplace claims are related to mental health.

“A 60 day or a 90 day waiting period can be the difference between somebody actually being able to get back into the workforce and not being able to get back into the workforce,” she said. “We have data that says the more supportive a supervisor is, the greater the return to work outcome will be for an individual.”

TelstraSuper’s Kathryn Forrest

Jane Hogan, insurance governance specialist at First State Super, said one of their biggest problems in tackling mental health was that members did not tell the super fund soon enough when they had a problem that needed addressing.

“A lot of it comes from members really not having a great understanding of what the insurance is that they’ve got and the expectations of not being set early about what the claims process will be,” Hogan told the roundtable. “We’re not finding out early enough.”

Alexa Lalli, an injury manager at Lendlease, said the construction company engaged their employees early to support them throughout their journey to recovery. She said having a team made up of health professionals with a background in insurance helped.

“We are seeing a lot more success because the claims process is positive and consistent,” she told the roundtable. “Our employees are reporting that it is a really good experience for them. And for us to be able to engage in those early return to work discussions. Even if someone is off work for three to four months, we always make sure there is a contact within our injury management team.”

Andrew Proebstl, the chief executive of LegalSuper, outlined the issues facing Australia’s legal industry which he said had the highest level of anxiety and depression of any white collar profession. He said that about 25 per cent of their insured claims were related to mental illness. EquipSuper’s head of people, Sarah Guthleben, said that secondary mental health issues also came up a lot in their claims processes.

Which policy?

“It’s a very relevant issue that is close to the minds of our board and also our management team,” Proebstl said at the roundtable.  “It’s a very predominant factor that we just can’t ignore even if we wanted to. Which of course we don’t.”

Margo Lydon, CEO of Superfriend, said insurers and funds needed to look at how to help people stay at work, which was key to tackling secondary mental health issues. She warned that the current designs of insurance products, like total & permanent disability (TPD) cover or income protection did not allow for a partial return to work.

“Policy design is so important,” she told the roundtable. “When we actually look at the population spread of people with severe and complex chronic long term mental illness, we’re talking about a fairly small proportion of all of those people who may have a diagnosable mental illness.”

Rohan Watson, a wellbeing coach at Mindstar, said there was a “critical window” for an employer, fund or insurer to help prevent someone’s injury or illness from manifesting into a secondary mental health condition. He said that some claims could take up to six months or more to be resolved.

Critical Window

“The critical window is the first two months when people are sitting there going out of their mind watching TV every day,” he said. “I really recognise just how important it is for people to actually be employed and be at work. And particularly return back to work when there’s been some health issues.”

CBus Super’s Darren Woolley

Darren Woolley, who manages the disability claims function at Cbus Super, said they also had a problem with late claims which were on average about three years from when their member had first become disabled. He also added that a “significant proportion” of claims had a secondary mental health component.

“I’d estimate, as we don’t record it, but it would probably be in the order of 60 percent or more that have those issues,” he said. “If we can get that addressed firstly by getting claims notified earlier, that then gives us some opportunity to address these issues that could develop down the track.”

Prime Super’s Murray Amies, who is a senior manager of insurance and member services, said he had seen cases where a claim was filed up to 10 years after a traumatic event had taken place. He also said his members were “quite intimidated by documentation” that was required to make a claim.

Shane Fielding, head of insurance at Hostplus, said the fund had built an in-house claims team to address some of these problems which gave them the “ability to engage very intimately” with members when they most needed it. That said, he also warned that by the time many of their members approach the fund, it was “a bit late to potentially impact their mental illness condition that may already have been prevalent as a secondary condition.”

Hostplus

Around 25 percent of Hostplus claims are related to primary mental illness ,while another 40 percent of the rest of the fund’s claims are linked with a secondary mental health condition, he said.

The roundtable also warned of the unintended consequences from the government’s incoming ‘Protect Your Super’ changes that will mean members under 25 with low balances will no longer receive life insurance cover automatically and will instead have to opt in. TelstraSuper’s Kathryn Forrest said the changes would lead “to a very different landscape” in 12 months where getting support for mental health became an issue of affordability.

Fielding said that about half of Hostplus’ members would lose insurance cover. “It means we won’t even have a chance to make an impact on these members’ lives because they won’t be able to claim,” he said. “On our fund, we hardly have any members with income protection. It’s a very low take up rate. So TPD is the main design for Hostplus.”

Noni Byron, managing director of Prestige Health Services Australia and a registered psychologist, said it was important for all industries to take a more “holistic snapshot of the individual” rather than compartmentalising a person based on a primary diagnosis. She added that there was “power” in a tailored rehabilitation program.

“We have lots of evidence about the power of rehabilitation and how to help people with recovery,” she told attendees. “It’s also about how you work with that individual and how you develop trust.”

AIA’s national rehabilitation manager Joanne Graves said the insurer had a suite of rehab services that covered mental health, musculoskeletal and cancer. All of them, she said, aimed to prevent the customers from developing a secondary condition. She concluded by saying that education was key.

“There is now a bit of a spotlight on the industry and with that we can gain some momentum and do some further education,” Graves said. “If we are all able to pull together and start to promote the support that is there, then that will help to not have claims lodged three years later because three years is too late.”

Sarah Jones is the deputy editor of Investment Magazine. She previously worked for Bloomberg News in London for more than 12 years covering equity markets and global asset management. Prior to moving to the UK, she worked for Australian Associated Press in Sydney covering economics and monetary policy.
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